Histopathological investigation of dental pulp reactions related to periodontitis

Abstract

Objective: Since the 1960s, there has been contradictory evidence regarding the association between periodontal pathology and the status of the pulp. The purpose of this study was to evaluate the histopathological changes of pulp tissue with severe periodontal disease, including vertical bone loss involving the major apical foramen, and compared them with the histological pulpal status of teeth with healthy periodontium. Methods: This case-controlled study included 35 intact teeth with severe periodontitis of hopeless prognosis (test group) and 35 teeth without periodontitis extracted for orthodontic reasons (control group). For each tooth, periodontal and endodontic parameters such as probing depth and pulpal vitality were recorded, and the pulp tissue was evaluated histologically. The data were analysed with a significance level of 0.05. Results: Vital pulp was observed in all specimens of both groups (P=1). Pulpal inflammation in the apical portion was observed in 81.71% of the severe periodontitis group, whereas all teeth in the control group demonstrated no signs of pulpal inflammation. Dystrophic calcification and pulp stones were observed in 7.5% of the periodontitis group and 5.7% of the healthy group (P>0.05). Pulp fibrosis was observed in 22.8% of the periodontitis group and 2.8% of the control group (P=0.012). Pulpal necrosis was not noted in either group. In the periodontitis group, internal resorption was present in 22.8% of cases (P=0.005) and external resorption was present in 80% of cases (P<0.001). In the control group, no internal or external resorption was observed in any of the specimens. No differences were noted in the study patients with regard to sex or age. Conclusion: Periodontal disease does not significantly affect pulp vitality and pulpal calcifications. However internal and/or external resorption was significantly different between the two groups as well as apical inflammation and pulp fibrosis.

Association between Periodontitis and Pulp Calcifications: Radiological Study

“…In contrast to the results of this study, other authors comparing teeth with various severities of attachment loss without caries and restorations [ 9 , 34 , 38 , 40 ] reported that periodontal disease can accelerate the pulp senescence process due to its interference with the nutritional supply of the pulp and concluded that periodontitis can cause the development of pulp calcifications and fibrosis [ 37 ].…”

“…In contrast to the results of this study, other authors comparing teeth with various severities of attachment loss without caries and restorations [9,34,38,40] reported that periodontal disease can accelerate the pulp senescence process due to its interference with the nutritional supply of the pulp and concluded that periodontitis can cause the development of pulp calcifications and fibrosis [37]. is could be explained by the existence of an association between pulp calcification and the presence of carious lesions and restorations and not necessarily the presence of attachment loss.…”

“…Furthermore, for others [ 3 , 38 ], total pulp disintegration can only be observed when the progression of the periodontitis is such that it extends to the apical foramen and the pathological process is terminal.…”

The effect of orthodontic forces on calcitonin gene-related peptide (CGRP) expression in the human periodontal ligament and its relationship with the human dental pulp

“…Sustained expression of CGRP will produce fibrosis of the tissue due to hyalinization and reduction of blood vessels replaced by mineralized tissue, thus an irreversible state will be produced in the pulp, reaching necrosis, and therefore, magnifying the inflammatory response of PDL and accentuating resorption processes (Fig. 1 ) ( 6 , 12 , 29 , 33 ).…”

Frequency and Distribution of Pulpal Calcifications in Teeth Involved in Jaw Tumors

“…The etiological factors of this process are still unknown; however, they are associated with different factors, such as trauma, pulp degeneration, orthodontic treatment, periodontal disease, caries, operative procedures, pulp inflammation, systemic diseases, or genetic conditions [9][10][11][12][13]. This process used to be associated with age; however, it has been observed that they are also found in young patients and in teeth that have not yet erupted [14].…”